Rheumatoid arthritis RA is an inflammatory autoimmune disorder characterized by joint painswelling, and synovial destruction. RA predominantly affects middle-aged women. The condition can also cause various extra-articular manifestations such as rheumatoid nodules and pulmonary fibrosis.
Diagnosis is mainly based on clinical features e. X-ray findings e. Early intervention with disease-modifying antirheumatic drugs DMARDs plays a decisive role in successful treatment. RA is not curable, but early effective treatment may help offset severe complications e. References:  . Epidemiological data refers to the US, unless otherwise specified.
References:  . References:  . DIP joints are not typically affected in RA! References:       . RA normally spares the thoracic and lumbar spine. In some cases, it initially affects the cervical spinecausing early-morning neck pain at rest. If a patient has arthritis, splenomegalyand neutropeniaconsider Felty syndrome.
References:     . The diagnosis of RA is based on diagnostic criteria that include laboratory testing. Imaging may support the diagnosis, but radiological joint findings are no longer included in the criteria, as they often become evident only in late stages of disease.
Before undergoing general anesthesia, airway and neck assessment is crucial in patients with rheumatoid arthritis. Atlanto-axial subluxation may be present, which increases the risk for spinal cord injury. Preoperative flexion -extension radiographs can help to evaluate the position of the cervical vertebra atlas C1 with regard to the axis C2. References:         . References:    .
References:  . References:       . References:     . We list the most important complications. The selection is not exhaustive.Calcium pyrophosphate dihydrate crystal deposition disease CPPD is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth, and swelling inflammation in some joints.
It usually affects one joint at a time, but sometimes it may affect several joints at once. Some symptoms of CPPD may appear to be symptoms of rheumatoid arthritis or osteoarthritis. CPPD commonly affects the knee or wrist. Less often, it can involve the hips, shoulders, elbows, knuckles, toes, or ankles.Pseudogout
CPPD affects both men and women. It occurs more frequently in people as they age, commonly affecting people over age People who have a thyroid condition, kidney failureor disorders that affect calcium, phosphate, or iron metabolism have an increased risk for CPPD.
The condition is also commonly present in people who have osteoarthritis. CPPD in young patients is unusual. Its occurrence should lead the doctor to look for certain metabolic and hereditary disorders.
Less often, CPPD may cause persistent swelling, warmth, and pain in several joints, and can even mimic rheumatoid arthritis. This condition results from the abnormal formation of calcium pyrophosphate dihydrate CPPD crystals in the cartilage cartilage is the "cushion" between the bones or the joint fluid synovial fluidwhich can lead to a sudden attack of arthritis, similar to gout.
The cause of abnormal deposits of CPPD crystals in cartilage is often unknown. CPPD crystals may be seen associated with some underlying disorders such as injury to the joint, hyperparathyroidismhypomagnesemia, hypophosphatasia, hypothyroidismand hemochromatosis. The abnormal formation of CPPD crystals may also be a hereditary trait. Cleveland Clinic is a non-profit academic medical center.
Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Calcium Pyrophosphate Dihydrate Deposition Disease CPPD, or Pseudogout Pseudogout or "false gout" is a form of arthritis that results from deposits of calcium pyrophosphate crystals its medical term is calcium pyrophosphate dihydrate crystal deposition disease, or CPPD. It commonly affects the knees and wrists. What is calcium pyrophosphate dihydrate crystal deposition disease CPPD, or pseudogout?
Who is affected by calcium pyrophosphate dihydrate crystal deposition disease CPPD, or pseudogout? What are the symptoms of acute calcium pyrophosphate dihydrate crystal deposition CPPD, or pseudogout? Sudden, intense joint pain Swollen joint that is warm and tender to touch Red skin involving the affected joint Less often, CPPD may cause persistent swelling, warmth, and pain in several joints, and can even mimic rheumatoid arthritis.
What causes calcium pyrophosphate dihydrate crystal deposition disease CPPD, or pseudogout? Show More.Thrombotic thrombocytopenic purpura TTP is a thrombotic microangiopathya condition in which microthrombi, consisting primarily of plateletsform and occlude the microvasculature i.
The other main thrombotic microangiopathy is hemolytic uremic syndrome HUS. TTP occurs primarily in adults and is typically due to acquired autoantibodies against a proteolytic enzyme that cleaves von Willebrand factor vWF. It is a clinical diagnosis based on the following pentad of findings: feverneurological abnormalities, thrombocytopeniamicroangiopathic hemolytic anemiaand impaired renal function.
If TTP is strongly suspected and initial laboratory tests support the diagnosis, treatment should begin immediately, as the condition may be fatal if left untreated. First-line treatment is plasma exchange therapy. References:  . Epidemiological data refers to the US, unless otherwise specified.
References:    . TTP is a thrombotic microangiopathya condition in which microthrombi form and occlude the microvasculature. References:    . TTP patients are typically previously healthy adults.
The pentad of clinical findings consists of:. The typical patient is a previously healthy adult presenting with mental status changes, feverpetechiaefatigueand pallor. Laboratory tests will then indicate hemolytic anemia and possibly acute kidney injury AKI.
Impaired kidney function may not be present, and only a minority of patients will present with all five clinical findings. References:   . References:   . See differential diagnosis of platelet disorders. Treatment should be started after a presumptive diagnosis is made based on clinical features and initial labs e. TTP requires urgent diagnosis and treatment! References: .2000 international 4900 wont start
TTP can result in microthrombus formation and complications in many organs of the body. References:    . We list the most important complications. The selection is not exhaustive. The prognosis depends primarily on prompt initiation of treatment. Timely treatment can prevent acute complications AKIcomaand deathas well as progression to chronic renal failure. References:  . Clinical science Thrombotic thrombocytopenic purpura TTP is a thrombotic microangiopathya condition in which microthrombi, consisting primarily of plateletsform and occlude the microvasculature i.
The pentad of clinical findings consists of: Fever Neurological signs and symptoms Altered mental status ;delirium Seizurefocal defects ;stroke Headachedizziness Low platelet count i.
The differential diagnoses listed here are not exhaustive. Platelet transfusion should only be reserved for patients who are bleeding or require an invasive procedure. CNS : seizurescoma ;strokeparesis GI tract : hemorrhagic colitis ; bowel necrosisperforation, stricture; peritonitis ; intussusception Heart : ischemia and fluid overload Pancreas : transient or permanent diabetes mellitus Liver : hepatomegalytransaminase elevations Kidney : hypertensionchronic kidney disease CKDend-stage renal disease ESRD References:     We list the most important complications.
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Your doctor may withdraw a sample of the fluid from your affected joint with a needle to test for the presence of crystals. X-rays of your affected joint often can reveal joint damage and crystal deposits in the joint's cartilage. There's no cure for pseudogout, but a combination of treatments can help relieve pain and improve the joint's function. To relieve pain and pressure in an affected joint, your doctor inserts a needle and removes some of the joint fluid, which helps remove some of the crystals from the joint.
The doctor will then inject the joint with a numbing medication and a corticosteroid to decrease inflammation. You'll probably first see your family doctor. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions rheumatologist. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version.
This content does not have an Arabic version. Diagnosis Pseudogout signs and symptoms can mimic those of gout and other types of arthritis, so lab and imaging tests are usually necessary to confirm a diagnosis.
Lab tests Blood tests can check for problems with your thyroid and parathyroid glands, as well as for a variety of mineral imbalances that have been linked to pseudogout.
More Information X-ray. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. American College of Rheumatology. Accessed May 14, Becker MA, et al. Pathogenesis and etiology of calcium pyrophosphate crystal deposition disease.
Treatment of calcium pyrophosphate crystal deposition disease. Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition disease.Valvoline vs pennzoil
Calcium pyrophasphate deposition CPPD disease. Arthritis Foundation. Terkeltaub, R. New insights into CPPD. The Rheumatologist. Related Associated Procedures X-ray. Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.Gout is a common inflammatory arthropathy characterized by painful and swollen joints resulting from precipitating uric acid crystals. Acute gout attacks typically manifest with a severely painful big toe podagra and occur most often in men following triggers such as alcohol consumption.
Diagnosis is based on clinical presentation and synovial fluid analysiswhich reveals negatively birefringent monosodium urate crystals. Acute attacks are treated with nonsteroidal anti-inflammatory drugs e. Epidemiological data refers to the US, unless otherwise specified.
Insufficient excretion or increased production of purines lead to hyperuricemiawhich predisposes to gout and possibly triggers acute gout attacks. Primary hyperuricemia can be aggravated by poor dietary habits.
Acute gouty arthritis is not always associated with elevated serum uric acid levels. It can also occur when serum uric acid is normal. Proton pump inhibitors should be given to patients being treated with both NSAIDs and glucocorticoids to avoid gastrointestinal ulcers.
First-line treatment. Xanthine oxidase inhibitor allopurinol . Second-line treatment. Uricosuric medications benzbromaroneprobenecidlesinurad.
Third-line treatment. Recombinant uricase pegloticase. The combination of allopurinol and azathioprine leads to increased bone marrow toxicity! During the first 2 weeks of an acute gout attack, treatment with urate -lowering drugs e. We list the most important complications. The selection is not exhaustive.Septic infectious arthritis is a bacterial infection of the joint space.
Contamination occurs either via the bloodstream, iatrogenicallyor by local extension e. Patients usually present with an acutely swollen, painful jointlimited range of motionand a fever. Suspected infectious arthritis requires prompt arthrocentesis for diagnosis. In addition to the immediate broad-spectrum antibiotic therapysurgical drainage and debridement may be necessary to prevent cartilage destruction and sepsis.
References:   . References:  . In order to avoid infection, strict sterile techniques should be ensured in any procedure that involves penetration of the joint space.
Bacterial coxitis is an orthopedic emergency! See purulent gonococcal arthritis and arthritis-dermatitis syndrome. Gonococcal arthritis is the most common form of arthritis in sexually active young adults! In a young, sexually active adult presenting with classic symptoms of septic arthritis, gonococcal infection must be ruled out! See Lyme arthritis. References:      . Suspected septic arthritis requires aspiration of synovial fluid for analysis! References:    .
Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD, or Pseudogout)
Synovial fluid analysis : comprises a group of tests that examine joint synovial fluid to aid in definitively establishing the specific types of arthritis. References:   . Following arthrocentesis and culture, simultaneous empiric antibiotic therapy based on the Gram stain and evacuation of purulent material should be performed. References:          .
References: . We list the most important complications. The selection is not exhaustive. Clinical science Septic infectious arthritis is a bacterial infection of the joint space. Mechanism of infection Hematogenous spread most common From a distant site e.You can opt in for push notifications, which allows you to keep up to date with all of the offers and promotions.
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